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Chronic Diseases and Patients’ Involvement in Care: The case of National Policies on Diabetes in Mali

par Martini, Jessica ;Tijou-Traoré, Annick;Gobatto, Isabelle;Dujardin, Bruno
Référence Global Symposium on Health System Reseach(2: 31/10/2012 - 03/11/2012: Pékin, Chine), Book of abstracts
Publication Publié, 2012-10-31

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Résumé :

The mounting burden of chronic diseases in African countries could be a good opportunity to strengthen their health systems introducing innovative care models. Chronic diseases imply important changes in people’s lives and require adapted care. Extensive literature from Northern countries and pilots from Southern ones prove for example how important is a patient-centered approach in caring non-communicable diseases and strong evidence exists worldwide about the benefits of psychosocial support for people living with HIV/AIDS. However, are policy makers, implementers and patient associations prepared to this revolution? How do stakeholders conceive patients’ involvement in care, what are their care models and how these influence national policies? Since 2010, we have analyzed national strategies to prevent and fight against diabetes in Mali. We conducted qualitative interviews with key stakeholders (19) involved in the policy-making process: policy-makers, health professionals, representatives of NGOs and patient associations. In Mali, diabetic patients first mobilized in 1991, and the disease enjoys social acceptance. However, a national policy on diabetes has not yet been adopted by the government. Moreover, given limitations in funding, human resources and international donors’ support, policy-makers focus mainly on clinical and financial components of diabetes care, neglecting patients-centered ones. Interviews and analysis of strategic documents show how the “chronicity” condition and its implications for diabetics are still little acknowledged or integrated into policies and care practice. While activities such as peer support, therapeutic education or patients’ involvement in the policy dialogue are supported for a chronic disease like HIV/AIDS, this is not yet the case for diabetes. Limited financial resources and international support, the recognized status of diabetes at national level seem to be major factors influencing existing care models and patients’ expected role. To improve care and introduce effective innovative care models, “chronicity” implications for patients’ lives should be better acknowledged by stakeholders.